,,ii  #aad? ,,congress  #a/ ,session    
,s4 #baig  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #bb1 #bjae,mr4 
,crapo 7= himself1 ,mr4 ,b5net1 & ,mr4  
,isakson7 introduc$ ! foll[+ bill2 :i* 0
 read twice & ref]r$ to ! ,committee on 
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve ! risk adju/m5t "u ! ,m$ic>e    
,advantage program1 & = o!r purposes4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,secur+ ,c>e = ,s5iors ,act ( #bjae4  
#b4 ,improvem5ts to ,,ma risk adju/m5t  
sy/em ,section #ahec7;a77#a77;,c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bc7;a77#a77;,c77 is am5d$ by    
add+ at ! end ! foll[+ new clauses3     
7iv7 ,evaluation & subsequ5t revision ( 
! risk adju/m5t sy/em to acc\nt = *ronic
 conditions & o!r factors = ! purpose ( 
mak+ ! risk adju/m5t sy/em m accurate1  
transp>5t1 & regul>ly updat$  7,i7      
,revision bas$ on numb] ( *ronic        
conditions ,! ,secret>y %all revise =   
#bjag & p]iodically !reaft]1 ! risk     

adju/m5t sy/em "u ?is subp>agraph s t a 
risk score "u su* sy/em1 ) respect to an
 individual1 takes into acc\nt ! numb] (
 *ronic conditions ) :i* ! individual   
has be5 diagnos$4  7,,ii7 ,evaluation ( 
diff]5t risk adju/m5t models ,!         
,secret>y %all evaluate ! impact (      
includ+ two ye>s ( data to comp>e !     
models us$ to det]m9e risk scores =     
#bjac & #bjad "u su* sy/em4  7,,iii7    
,evaluation & analysis on *ronic kidney 
disease 7,,ckd7 codes ,! ,secret>y %all 
evaluate ! impact ( remov+ ! diagnosis  
codes relat$ to *ronic kidney disease 9 
! #bjad risk adju/m5t model & conduct an
 analysis ( be/ practices ( ,,ma plans  
to sl[ disease progression relat$ to    
*ronic kidney disease4  7,,iv7          
,evaluation & recomm5dations on use (   
enc\nt] data ,! ,secret>y %all evaluate 
! impact ( includ+ #aj p]c5t ( enc\nt]  
data 9 comput+ paym5t = #bjaf & !       
read9ess ( ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices to incorporate enc\nt] data 9  
risk scores4 ,9 conduct+ su* evaluation1

 ! ,secret>y %all use data collect$ z   
enc\nt] data on or aft] ,janu>y #a1     
#bjab1 %all conduct /ati/ical analyses  
on su* data = accuracy & complet5ess &  
issue recomm5dations = improv+ su*      
accuracy & complet5ess1 & %all n        
increase ! p]c5tage ( su* enc\nt] data  
us$ unless ! ,secret>y releases !       
results ( ! analyses publicly1 indicates
 h[ su* data w be weight$ 9 comput+ !   
risk scores1 & ensures t ! data reflects
 ! degree & co/ ( c>e coord9ation "u    
,,ma plans4  7,v7 ,conduct ( evaluations
 ,evaluations & analyses "u subclauses  
7,,ii7 ?r\gh 7,,iv7 %all include an     
actu>ial op9ion f ! ,*ief ,actu>y ( !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices ab\t
 ! reasonabl5ess ( ! me?ods1            
assumptions1 & conclusions ( su*        
evaluations & analyses4 ,! ,secret>y    
%all consult ) ! ,m$ic>e ,paym5t        
,advisory ,commission & accept & consid]
 comm5ts ( /akehold]s1 su* z manag$ c>e 
organizations & b5efici>y gr\ps1 on su* 
evaluation & analyses4 ,! ,secret>y %all

 complete su* evaluations & analyses 9 a
 mann] t p]mits ! results to be appli$ =
 plan ye>s beg9n+ ) ! second plan ye> t 
beg9s aft] ! date ( ! enactm5t ( ?is    
clause4  7,,vi7 ,implem5tation (        
revisions bas$ on evaluations ,if !     
,secret>y det]m9es1 bas$ on su* an      
evaluation or analysis1 t revisions to !
 risk adju/m5t sy/em to address ! matt]s
 describ$ 9 any ( subclauses 7,,ii7     
?r\gh 7,,iv7 w\ld make ! risk adju/m5t  
sy/em "u ?is subp>agraph bett] reflect &
 appropriately weight = ! population t  
is s]v$ by ! plan1 ! ,secret>y %all1    
beg9n+ ) #bjag1 & p]iodically !reaft]1  
make su* revisions4  7,,vii7 ,p]iodic   
report+ to ,congress ,) respect to plan 
ye>s beg9n+ ) #bjag & e ?ird ye>        
!reaft]1 ! ,secret>y %all submit to     
,congress a report on ! mo/ rec5t       
revisions 7if any7 made "u ?is clause1  
includ+ ! evaluations conduct$ "u       
subclauses 7,,ii7 ?r\gh 7,,iv74  7v7 ,no
 *anges to adju/m5t factors t prev5t    
activities consi/5t ) national heal?    

policy goals ,9 mak+ any *anges to !    
adju/m5t factors1 includ+ adju/m5t =    
heal? /atus "u p>agraph 7#c71 !         
,secret>y %all ensure t ! *anges d n    
prev5t ,m$ic>e ,advantage organizations 
f p]=m+ or und]tak+ activities t are    
consi/5t ) national heal? policy goals1 
includ+ activities to promote e>ly      
detection & bett] c>e coord9ation1 ! use
 ( heal? risk assessm5ts1 c>e plans1 &  
programs to sl[ ! progression ( *ronic  
diseases4  7vi7 ,opportunity = review & 
public comm5t reg>d+ *anges to adju/m5t 
factors ,= *anges to adju/m5t factors   
effective = #bjag & subsequ5t ye>s1 9   
addition to provid+ notice ( su* *anges 
9 ! ann\ncem5t "u subsection 7b77#b71 ! 
,secret>y %all provide an opportunity = 
review ( propos$ *anges ( n less ?an #fj
 days & a public comm5t p]iod ( n less  
?an #cj days be=e implem5t+ su* *anges4 
4  #c4 ,s5se ( congress relat+ to m$ic>e
 advantage risk adju/m5t ,x is ! s5se ( 
,congress t-- 7#a7 ! ,secret>y ( ,heal? 
& ,human ,s]vices %\ld p]iodically      

monitor & improve ! ,m$ic>e ,advantage  
risk adju/m5t model to ensure t x       
accurately acc\nts = b5efici>y risk1    
includ+ = ^? individuals ) complex      
*ronic comorbid conditions2  7#b7 !     
,secret>y %\ld closely exam9e ! curr5t  
,m$ic>e ,advantage risk adju/m5t        
me?odology to ensure t plans enroll+    
b5efici>ies ) ! greate/ heal? c>e ne$s  
receive adequate reimbursem5t to deliv] 
high-quality c>e & o!r s]vices to help  
b5efici>ies avoid co/ly complications & 
fur!r progression ( *ronic conditions & 
to ! ext5t data indicate ?is to be !    
case1 ! ,secret>y %\ld make necess>y    
adju/m5t to ! risk adju/m5t me?odology2 
&  7#c7 ! ,secret>y %\ld reconsid] !    
implem5tation ( *anges 9 ! ,m$ic>e      
,advantage risk adju/m5t me?odology     
f9aliz$ = #bjaf & to use to ! ext5t     
appropriate ! me?odology f9aliz$ 9 #bjae
 = "o additional ye>4